Saturday, June 20, 2009

Baby Deaths from ‘Natural Causes’

It's simply not enough to say a baby in custody died of 'natural causes.' A neglected baby dying of malnutrition or unattended medical conditions would also die of a 'natural cause,' it may be argued.

As far as international human rights instruments go, the word 'custody' does not refer exclusively to jails or police detention centers. It also refers to all situations where people or children are kept in institutions managed by the state, except on a purely 'voluntary' basis. Thus borstals and children's homes come under this definition.

It is the responsibility of the state and those in charge of custodial institutions to ensure that basic needs of the inmates are met, including food and health care. In addition to establishing systems and benchmarks to ensure that basic services are provided it is important to organize a system of regular inspections. Further, in case of any serious mishap like death, a full and impartial inquiry must be conducted.

Questions that need to be answered in such an inquiry would include: Was the child's nutrition adequately taken care of? Did the baby suffer from a disease? Was it treated for the condition? If the baby did not respond to treatment, was it evaluated for referral abroad? Was there any neglect, and if so who was responsible?

It's simply not enough to say one has regulations on paper. They must also work on the ground. And how does one conclude a baby died of 'natural causes' before the inquiry has even begun?


Anonymous said...

Dear Dr Waheed,

I do condemn the callousness with which the state services are investigating these kinds of cases. However, I must add these points for consideration to make the matter more clear or perhaps just for the sake of argument.

As a doctor, I am sure you'd be able to believe that at times, in fact quite frequently in Maldives, kids are undernourished because of difficulties with feeding - not because of specific neglect or non-availability of food. I am aware of many kids who have caring and loving parents who just don't grow well. They are under weight for age, sometimes by a good many kilos. Could it therefore be possible, and wouldn't it be fair to consider, that the case in question was not a neglected malnourished case?

Furthermore, would you also not consider the "congenital" heart disease itself to be a cause of the poor growth. As a layman, I am ready to believe that it could be.

A "hole in the heart" is a very vague term. I am sure you'd agree. Could it be the case, as I have been told by some very knowledgeable doctors in Srilanka, that the cardiac condition that this child had was beyond "repair"? I have been made to believe that the child was assessed for need for surgery and surgery declined on medical grounds. I am not able to get information whether that meant surgery was not required or whether the risks were too grave.

On a different note though, and about another kid. I thought I should share this with you. I had the fortune of meeting the father of a child who was recently admitted to IGMH whose child too had a heart defect by birth. In his case; he was sent abroad under state welfare. The funds initially provided were only sufficient for initial investigation and treatment. They were told, by welfare services, that if surgery was advised further funds would be made available. Anyway, at the specialist hospital in India surgery was advised. But upon informing this to the welfare services the father was informed, in writing, that funds would not be provided!!

That child was brought back to Male'. Father had no option. He was admitted to hospital in Male'. And again referred abroad for surgery. This father came to be because he wanted me to contribute money to support the surgery as he feared the government welfare would not support them. Like the case you have written about, this was also a failure of the system.


misdd said...

Thank you Dr Waheed. As a mother myself I am still reeling from the news. I don't know how the government can pass this poor babies death as, "natural causes", and sweep it under the carpet. There is "negligence" on the government's part written all over this incident. May be that is why.I am really glad that you have blogged about this, as I am really upset that there is not enough representation on behalf of this baby made among the Maldives blogging community. Thank you.

Abdullah Waheed's Blog said...

Dear Sameera,

All the points you raise are quite valid. Some congenital heart diseases are surgically correctable, while many others are not.

I don't have any more details of the medical history of the child except what has been reported. So i was not commenting on that aspect.

I was simply hilighting the neccessity of fully investigating major incidents while in custody. Such incidents are the tip of the iceberg.

Anonymous said...

I agree with you Dr Waheed that custodial deaths not only mean deaths in prison, and as such all deaths while people are under the care of the state should be treated equally.

I think what we fail to understand in this country is the basic concept of human rights, including even within the HRC itself. In fact, it is extremely important that all government departments operate on a rights-based approach so that we have a just and equitable society.